Poster Session 1
Kathleen M. Pulice, DO (she/her/hers)
OB/GYN
Lehigh Valley Health Network
Macungie, PA, United States
Shekinah Dosunmu, MD
Lehigh Valley Health Network
Allentown, Pennsylvania, United States
Joanne N. Quiñones, MD, MSCE (she/her/hers)
Program Director, Maternal Fetal Medicine Fellowship; VC Research, Dept OBGYN
Lehigh Valley Health Network
Allentown, Pennsylvania, United States
Meredith Rochon, MD (she/her/hers)
Chief, Division of Maternal Fetal Medicine
Lehigh Valley Health Network
Allentown, Pennsylvania, United States
Amanda B. Flicker, MD
Obstetrics and Gynecology Department Chair
Lehigh Valley Health Network
Allentown, Pennsylvania, United States
Travis Dayon, MD
Lehigh Valley Health Network
Allentown, Pennsylvania, United States
George Angelakakis
University of South Florida Morsani College of Medicine, SELECT Program
Tampa, Florida, United States
Ahsan Usmani
University of South Florida Morsani College of Medicine, SELECT Program
Tampa, Florida, United States
Janae Cornwall, BS
Medical Student
University of South Florida Morsani College of Medicine, SELECT Program
Tampa, Florida, United States
.jpg "Danielle Durie, MD, MPH (she/her/hers) photo")
Danielle Durie, MD, MPH (she/her/hers)
Vice Chair of Quality and Patient Safety, Dept of ObGyn
Lehigh Valley Health Network
Allentown, Pennsylvania, United States
The ARRIVE trial found that elective induction of labor (eIOL) at 39 weeks in nulliparous persons compared to expectant management was associated with a lower rate of cesarean delivery (CD). Our goal was to see if this benefit persisted in a non-research setting.
Study Design: Retrospective cohort study of all nulliparous pregnant persons admitted for delivery ≥ 39w0d at a single academic community institution between 3/1/20-3/1/22, when we started offering eIOL. Those with singleton low risk pregnancies, without any clinical indication for delivery prior to 40w5d, were included. Maternal and neonatal outcomes of persons undergoing eIOL between 39w0d-39w4d were compared to women expectantly managed. The primary outcome was rate of CD. Secondary outcomes included select maternal outcomes and composite neonatal outcome (neonatal death and/or serious morbidity).
Results:
1009 nulliparous persons with low-risk singleton gestations admitted for delivery during the study period were identified, 149 (14.8%) undergoing eIOL and 860 (85.2%) expectantly managed. Those undergoing eIOL delivered earlier (39.2 vs 40.1 wks, p< 0.001), were more likely to be obese (38.8% vs 20.4%, p< 0.001) and were less likely to be of advanced maternal age (4.0% vs 9.3%, p=0.033). There was no difference in CD rate (20.8% vs 17.8%, p=0.38), maternal outcomes or composite neonatal outcome between the eIOL and expectant management groups (Table). eIOL was associated with longer maternal length of stay (LOS) but similar neonatal LOS. When evaluating only those undergoing induction, CD rate was significantly lower in the eIOL group (20.8% vs 32.9%, p=0.019).
Conclusion:
In our cohort of low-risk nulliparous pregnant persons in a non-research setting, eIOL at 39w0d-39w4d did not decrease CD rate, which differs from the ARRIVE trial results. Reassuringly, there was no increase in adverse outcomes, confirming that eIOL is safe. In low-risk patients, induction at 39w0d-39w4d may be associated with a lower CD rate than induction later in gestation.
